title: Live anatomy of the perineal body in patients with third-degree rectocele.
abstract: OBJECTIVE
  In many pelvic floor disorders, the perineal body is damaged or destroyed. There is still a considerable variation in anatomical descriptions of the perineal body and even more debate with regard to its attachments and relationships. Cadaveric dissections do not always reflect the functional behaviour of structures in the pelvis and description of live anatomy on imaging studies is not always reliable. This study aimed to define the anatomy of the perineal body in patients with rectocele during the live dissection required for minimally invasive surgical repair.
  
  
  METHODS
  From January 2007 to December 2009 consecutive patients requiring surgery for third-degree rectocele and symptoms of obstructed defaecation were recruited. Participants underwent dissection of the perineal body, rectum and vagina preliminary to a tissue fixation system, an operation which inserts a tensioned tape to repair the perineal body.
  
  
  RESULTS
  Thirty Caucasian female patients, mean age 61 (range 47-87) years, mean parity 2.6 (range 1-5), were included. Live dissection demonstrated that the perineal body was divided into two parts, joined by a stretched central part, anchored laterally by the deep transverse perineii muscle to the descending ramus of the pubic bone. The mean longitudinal length of the perineal body was 4.5 (3.5-5.5) cm, accounting for 50% of the posterior vaginal support.
  
  
  CONCLUSIONS
  In women with low rectocele, the perineal body appears to be divided into two parts, severely displaced behind the ischial tuberosities.
authors.affiliation: Clinic of Urology, Pediatric Urology and Andrology, Justus-Liebig-University, Giessen, Germany.
authors.forename: F M E
authors.initials: FM
authors.lastname: Wagenlehner
authors.forename: E
authors.initials: E
authors.lastname: Del Amo
authors.forename: G A
authors.initials: GA
authors.lastname: Santoro
authors.forename: P
authors.initials: P
authors.lastname: Petros
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003238:Connective Tissue / Q000473:pathology; D004210:Dissection; D019160:Endosonography; D005260:Female; D006801:Humans; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000473:pathology; D017773:Pelvic Floor / Q000000981:diagnostic imaging / Q000473:pathology*; D010502:Perineum / Q000000981:diagnostic imaging / Q000473:pathology*; D020047:Rectocele / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*
keywords: Endovaginal ultrasonography; obstructed defaecation; perineal body; rectocele; transperineal ultrasonography